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Editorial
January 19, 2021

Intravenous Thrombolysis Before Endovascular Thrombectomy for Acute Ischemic Stroke

Author Affiliations
  • 1Comprehensive Stroke Center, Department of Neurology, University of California, Los Angeles
  • 2Associate Editor, JAMA
  • 3Departments of Emergency Medicine and Neurosurgery, University of Cincinnati, Cincinnati, Ohio
JAMA. 2021;325(3):229-231. doi:10.1001/jama.2020.22388
Conversations with Dr Bauchner (21:48)
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The 2 reperfusion therapies of proven benefit for acute ischemic stroke, mechanical endovascular thrombectomy (EVT) and pharmacologic intravenous thrombolysis (IVT), have complementary advantages. EVT, which involves mechanical debulking, works well for accessible sizeable thrombi that occlude large cerebral vessels and are resistant to rapid thrombolytic dissolution. IVT, which involves chemical dissolution, works well for smaller thrombi that occlude medium and small cerebral vessels inaccessible or poorly accessible to endovascular technology. An open, important question has been whether the modest efficacy of IVT for large vessel occlusions is sufficient to make the strategy of initiating IVT prior to EVT more effective than pursuing EVT alone.

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